{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:46:29Z","timestamp":1791953189570,"version":"4.3.4"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Musculoskelet Surg"],"DOI":"10.1007\/s12306-026-00973-6","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:44:33Z","timestamp":1791927873000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Medial joint opening on immediate postoperative supine radiographs predicts inferior midterm functional outcomes in women after total knee arthroplasty"],"prefix":"10.1007","author":[{"given":"Eran","family":"Keltz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenie","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libby","family":"Spiers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Tirosh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saud","family":"Almaslmani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Vorgin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phong","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"1","key":"973_CR1","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1007\/s11999-009-1112-3.PMID:19789934;PMCID:PMC2795818","volume":"468","author":"DA Dennis","year":"2010","unstructured":"Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin OrthopRelat Res 468(1):102\u2013107. https:\/\/doi.org\/10.1007\/s11999-009-1112-3.PMID:19789934;PMCID:PMC2795818","journal-title":"Clin OrthopRelat Res"},{"issue":"7","key":"973_CR2","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1016\/j.arth.2015.01.053","volume":"30","author":"K Nagai","year":"2015","unstructured":"Nagai K, Muratsu H, Matsumoto T, Takahara S, Kuroda R, Kurosaka M (2015) Influence of intraoperative soft tissue balance on postoperative active knee extension in posterior-stabilised total knee arthroplasty. J Arthroplasty 30(7):1155\u20131159. https:\/\/doi.org\/10.1016\/j.arth.2015.01.053","journal-title":"J Arthroplasty"},{"issue":"8","key":"973_CR3","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1055\/s-0039-1688504","volume":"33","author":"T Matsumoto","year":"2020","unstructured":"Matsumoto T, Takayama K, Ishida K, Kuroda Y, Tsubosaka M, Muratsu H, Hayashi S, Hashimoto S, Matsushita T, Niikura T, Kuroda R (2020) Intraoperative soft tissue balance\/kinematics and clinical evaluation of modified kinematically versus mechanically aligned total knee arthroplasty. J Knee Surg 33(8):777\u2013784. https:\/\/doi.org\/10.1055\/s-0039-1688504","journal-title":"J Knee Surg"},{"key":"973_CR4","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/01.blo.0000238792.36725.1e","volume":"452","author":"J Victor","year":"2006","unstructured":"Victor J, Bellemans J (2006) Physiologic kinematics as a concept for better flexion in TKA. Clin OrthopRelat Res 452:53\u201358. https:\/\/doi.org\/10.1097\/01.blo.0000238792.36725.1e. (PMID: 16924173)","journal-title":"Clin OrthopRelat Res"},{"key":"973_CR5","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1097\/00003086-200111000-00041","volume":"392","author":"TK Fehring","year":"2001","unstructured":"Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin OrthopRelat Res 392:315\u2013318. https:\/\/doi.org\/10.1097\/00003086-200111000-00041. (PMID: 11716402)","journal-title":"Clin OrthopRelat Res"},{"issue":"3","key":"973_CR6","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1111\/os.12123.PMID:25179351;PMCID:PMC6583264","volume":"6","author":"N Kumar","year":"2014","unstructured":"Kumar N, Yadav C, Raj R, Anand S (2014) How to interpret postoperative X-rays after total knee arthroplasty. Orthop Surg 6(3):179\u2013186. https:\/\/doi.org\/10.1111\/os.12123.PMID:25179351;PMCID:PMC6583264","journal-title":"Orthop Surg"},{"issue":"7","key":"973_CR7","doi-asserted-by":"publisher","first-page":"2431","DOI":"10.1016\/j.arth.2021.02.050","volume":"36","author":"AA Hart","year":"2021","unstructured":"Hart AA, DeMik DE, Brown TS, Noiseux NO (2021) Routine radiographs after total joint arthroplasty: is there clinical value? J Arthroplasty 36(7):2431\u20132434. https:\/\/doi.org\/10.1016\/j.arth.2021.02.050","journal-title":"J Arthroplasty"},{"key":"973_CR8","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1097\/00003086-199610000-00030","volume":"331","author":"MA Mont","year":"1996","unstructured":"Mont MA, Serna FK, Krackow KA, Hungerford DS (1996) Exploration of radiographically normal total knee replacements for unexplained pain. Clin OrthopRelat Res 331:216\u2013220. https:\/\/doi.org\/10.1097\/00003086-199610000-00030. (PMID: 8895641)","journal-title":"Clin OrthopRelat Res"},{"key":"973_CR9","doi-asserted-by":"publisher","unstructured":"Liebs TR, Kloos SA, Herzberg W, R\u00fcther W, Hassenpflug J. The significance of an asymmetric extension gap on routine radiographs after total knee replacement: A new sign and its clinical significance. Bone Joint J. 2013 Apr;95-B(4):472\u20137. https:\/\/doi.org\/10.1302\/0301-620X.95B4.31080. PMID: 23539698.","DOI":"10.1302\/0301-620X.95B4.31080"},{"key":"973_CR10","doi-asserted-by":"publisher","unstructured":"Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. https:\/\/doi.org\/10.1016\/j.jbi.2019.103208. Epub 2019 May 9. PMID: 31078660; PMCID: PMC7254481.","DOI":"10.1016\/j.jbi.2019.103208"},{"issue":"2","key":"973_CR11","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377\u2013381. https:\/\/doi.org\/10.1016\/j.jbi.2008.08.010","journal-title":"J Biomed Inform"},{"issue":"1","key":"973_CR12","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1302\/0301-620x.80b1.7859","volume":"80","author":"J Dawson","year":"1998","unstructured":"Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63\u201369. https:\/\/doi.org\/10.1302\/0301-620x.80b1.7859. (PMID: 9460955)","journal-title":"J Bone Joint Surg Br"},{"issue":"1","key":"973_CR13","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/0168-8510(96)00822-6","volume":"37","author":"R Brooks","year":"1996","unstructured":"Brooks R (1996) EuroQol: the current state of play. Health Policy 37(1):53\u201372. https:\/\/doi.org\/10.1016\/0168-8510(96)00822-6. (PMID: 10158943)","journal-title":"Health Policy"},{"issue":"8","key":"973_CR14","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/j.arth.2005.04.017","volume":"20","author":"Y Kalairajah","year":"2005","unstructured":"Kalairajah Y, Azurza K, Hulme C, Molloy S, Drabu KJ (2005) Health outcome measures in the evaluation of total hip arthroplasties\u2013a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty 20(8):1037\u20131041. https:\/\/doi.org\/10.1016\/j.arth.2005.04.017. (PMID: 16376260)","journal-title":"J Arthroplasty"},{"key":"973_CR15","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/00003086-200111000-00002","volume":"392","author":"GR Scuderi","year":"2001","unstructured":"Scuderi GR, Scott WN, Tchejeyan GH (2001) The Insall legacy in total knee arthroplasty. Clin OrthopRelat Res 392:3\u201314. https:\/\/doi.org\/10.1097\/00003086-200111000-00002. (PMID: 11716399)","journal-title":"Clin OrthopRelat Res"},{"issue":"20","key":"973_CR16","doi-asserted-by":"publisher","first-page":"1678","DOI":"10.2106\/JBJS.N.01256","volume":"97","author":"JD Roth","year":"2015","unstructured":"Roth JD, Howell SM, Hull ML (2015) Native Knee Laxities at 0\u00b0, 45\u00b0, and 90\u00b0 of Flexion and Their Relationship to the Goal of the Gap-Balancing Alignment Method of Total Knee Arthroplasty. J Bone Joint Surg Am 97(20):1678\u20131684. https:\/\/doi.org\/10.2106\/JBJS.N.01256. (PMID: 26491132)","journal-title":"J Bone Joint Surg Am"},{"key":"973_CR17","doi-asserted-by":"publisher","unstructured":"Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K. The flexion gap in normal knees. An MRI study. J Bone Joint Surg Br. 2004 Nov;86(8):1133\u20136. https:\/\/doi.org\/10.1302\/0301-620x.86b8.15246. PMID: 15568525.","DOI":"10.1302\/0301-620x.86b8.15246"},{"issue":"3","key":"973_CR18","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1177\/1602400305","volume":"24","author":"A Jawhar","year":"2016","unstructured":"Jawhar A, Hutter K, Scharf HP (2016) Outcome in total knee arthroplasty with a medial-lateral balanced versus unbalanced gap. J OrthopSurg (Hong Kong) 24(3):298\u2013301. https:\/\/doi.org\/10.1177\/1602400305. (PMID: 28031494)","journal-title":"J OrthopSurg (Hong Kong)"},{"issue":"2","key":"973_CR19","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.arth.2006.04.024","volume":"22","author":"J Romero","year":"2007","unstructured":"Romero J, St\u00e4helin T, Binkert C, Pfirrmann C, Hodler J, Kessler O (2007) The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty 22(2):235\u2013240. https:\/\/doi.org\/10.1016\/j.arth.2006.04.024. (PMID: 17275640)","journal-title":"J Arthroplasty"},{"issue":"12","key":"973_CR20","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1302\/2058-5241.3.180008.PMID:30697441;PMCID:PMC6335603","volume":"3","author":"LC Walker","year":"2018","unstructured":"Walker LC, Clement ND, Ghosh KM, Deehan DJ (2018) What is a balanced knee replacement? EFORT Open Rev 3(12):614\u2013619. https:\/\/doi.org\/10.1302\/2058-5241.3.180008.PMID:30697441;PMCID:PMC6335603","journal-title":"EFORT Open Rev"},{"issue":"1","key":"973_CR21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1302\/0301-620x.83b1.10632","volume":"83","author":"DA Dennis","year":"2001","unstructured":"Dennis DA, Komistek RD, Walker SA, Cheal EJ, Stiehl JB (2001) Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Joint Surg Br 83(1):33\u201339. https:\/\/doi.org\/10.1302\/0301-620x.83b1.10632. (PMID: 11245535)","journal-title":"J Bone Joint Surg Br"},{"issue":"9","key":"973_CR22","doi-asserted-by":"publisher","first-page":"3745","DOI":"10.1007\/s00167-023-07324-z","volume":"31","author":"SS Lee","year":"2023","unstructured":"Lee SS, Lee J, Alharthi H, Moon YW (2023) Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique. Knee Surg Sports Traumatol Arthrosc 31(9):3745\u20133754. https:\/\/doi.org\/10.1007\/s00167-023-07324-z","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"10","key":"973_CR23","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1016\/j.clinbiomech.2006.07.002","volume":"21","author":"CD Pollard","year":"2006","unstructured":"Pollard CD, Braun B, Hamill J (2006) Influence of gender, estrogen and exercise on anterior knee laxity. Clin Biomech (Bristol) 21(10):1060\u20131066. https:\/\/doi.org\/10.1016\/j.clinbiomech.2006.07.002","journal-title":"Clin Biomech (Bristol)"},{"issue":"6","key":"973_CR24","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.1007\/s00167-020-06293-x","volume":"29","author":"PM Lutz","year":"2021","unstructured":"Lutz PM, Feucht MJ, Wechselberger J, Rasper M, Petersen W, W\u00f6rtler K, Imhoff AB, Achtnich A (2021) Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity. Knee Surg Sports Traumatol Arthrosc 29(6):1960\u20131967. https:\/\/doi.org\/10.1007\/s00167-020-06293-x","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"8","key":"973_CR25","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.1097\/CORR.0000000000002184","volume":"480","author":"SS Elmasry","year":"2022","unstructured":"Elmasry SS, Sculco PK, Kahlenberg CA, Mayman DJ, Cross MB, Pearle AD, Wright TM, Westrich GH, Imhauser CW (2022) Arthroplasty surgeons differ in their intraoperative soft tissue assessments: a study in human cadavers to quantify surgical decision-making in TKA. Clin Orthop Relat Res 480(8):1604\u20131615. https:\/\/doi.org\/10.1097\/CORR.0000000000002184","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"973_CR26","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.ocl.2013.11.001","volume":"45","author":"M Roche","year":"2014","unstructured":"Roche M, Elson L, Anderson C (2014) Dynamic soft tissue balancing in total knee arthroplasty. Orthop Clin North Am 45(2):157\u2013165. https:\/\/doi.org\/10.1016\/j.ocl.2013.11.001","journal-title":"Orthop Clin North Am"},{"issue":"2","key":"973_CR27","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/j.arth.2020.08.025","volume":"36","author":"SJ MacDessi","year":"2021","unstructured":"MacDessi SJ, Cohen DA, Wood JA, Diwan AD, Harris IA (2021) Does the use of intraoperative pressure sensors for knee balancing in total knee arthroplasty improve clinical outcomes? A comparative study with a minimum two-year follow-up. J Arthroplasty 36(2):514\u2013519. https:\/\/doi.org\/10.1016\/j.arth.2020.08.025","journal-title":"J Arthroplasty"},{"issue":"7","key":"973_CR28","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.artd.2020.12.022.PMID:33553538;PMCID:PMC7850935","volume":"30","author":"MB Held","year":"2021","unstructured":"Held MB, Grosso MJ, Gazgalis A, Sarpong NO, Boddapati V, Neuwirth A, Geller JA (2021) Improved Compartment Balancing Using a Robot-Assisted Total Knee Arthroplasty. Arthroplast Today 30(7):130\u2013134. https:\/\/doi.org\/10.1016\/j.artd.2020.12.022.PMID:33553538;PMCID:PMC7850935","journal-title":"Arthroplast Today"}],"container-title":["MUSCULOSKELETAL SURGERY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-026-00973-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12306-026-00973-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-026-00973-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:06:20Z","timestamp":1791950780000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12306-026-00973-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":28,"alternative-id":["973"],"URL":"https:\/\/doi.org\/10.1007\/s12306-026-00973-6","relation":{},"ISSN":["2035-5114"],"issn-type":[{"value":"2035-5114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"18 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Western Health approved this study (approval no. QA2021.71).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare that are relevant to the content of this article.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}